Study of the Durability of Membrane Electrode Assemblies in Various Accelerated Stress Tests for Proton-Exchange Membrane Water Electrolysis.

In this work, we focus on the degradation of membrane electrode assemblies (MEAs) in proton-exchange membrane water electrolysis (PEMWE) induced by different accelerated stress tests (ASTs), including constant-current mode, square-wave mode, and solar photovoltaic mode. In constant-current mode, at continuous testing for 600 h at 80 °C, a degradation of operating voltage increased by the enhanced current density from 22 µV/h (1 A/cm2) to 50 µV/h (3 A/cm2). In square-wave mode, we found that in the narrow fluctuation range (1-2 A/cm2), the shorter step time (2 s) generates a higher degradation rate of operating voltage, but in the wide fluctuation range (1-3 A/cm2), the longer step time (22 s) induces a faster operating voltage rise. In the solar photovoltaic mode, we used a simulation of 11 h sunshine duration containing multiple constant-current and square-wave modes, which is closest to the actual application environment. Over 1400 h ASTs, the solar photovoltaic mode lead to the most serious voltage rise of 87.7 µV/h. These results are beneficial to understanding the durability of the PEM electrolyzer and optimizing the components of MEAs, such as catalysts, membranes, and gas diffusion layers.

Group III (In/Ga)-V (P/As)-VI (S/Se) Monolayers: A New Class of Auxetic Semiconductors with Highly Anisotropic Electronic/Optical/Mechanical/Thermal Properties.

We present a theoretical design of a class of 2D semiconducting materials, namely, group III (In/Ga)-V (P/As)-VI (S/Se) monolayers, whose global-minimum structures are predicted based on the particle swarm optimization method. Electronic structure calculations suggest that all group III-V-VI monolayers exhibit quasi-direct semiconducting characteristics with desirable band gaps ranging from 1.76 to 2.86 eV (HSE06 functional). Moreover, most group III-V-VI monolayers possess highly anisotropic carrier mobilities with large anisotropic ratios (3.4-6 for electrons, 2.2-25 for holes). G0W0+BSE calculations suggest that these monolayers show high optical anisotropy and relatively large exciton binding energies (0.33-0.75 eV), comparable to that (0.5 eV) of MoS2 monolayer. In particular, the GaPS monolayer manifests strikingly anisotropic I-V curves with a large ON/OFF ratio of ∼105 (106 for the GaPS bilayer) and anisotropic lattice thermal conductivity. Furthermore, the GaPS monolayer is predicted to exhibit both in-plane and out-of-plane negative Poisson ratios (NPRs) and prominent anisotropic Young moduli.

Concentrated Formic Acid from CO2 Electrolysis for Directly Driving Fuel Cell.

The production of formic acid via electrochemical CO2 reduction may serve as a key link for the carbon cycle in the formic acid economy, yet its practical feasibility is largely limited by the quantity and concentration of the product. Here we demonstrate continuous electrochemical CO2 reduction for formic acid production at 2 M at an industrial-level current densities (i.e., 200 mA cm-2 ) for 300 h on membrane electrode assembly using scalable lattice-distorted bismuth catalysts. The optimized catalysts also enable a Faradaic efficiency for formate of 94.2 % and a highest partial formate current density of 1.16 A cm-2 , reaching a production rate of 21.7 mmol cm-2 h-1 . To assess the practicality of this system, we perform a comprehensive techno-economic analysis and life cycle assessment, showing that our approach can potentially substitute conventional methyl formate hydrolysis for industrial formic acid production. Furthermore, the resultant formic acid serves as direct fuel for air-breathing formic acid fuel cells, boasting a power density of 55 mW cm-2 and an exceptional thermal efficiency of 20.1 %.

Odorant Binding Protein Expressed in Legs Enhances Malathion Tolerance in Bactrocera dorsalis (Hendel).

Bactrocera dorsalis is a highly invasive species and is one of the most destructive agricultural pests worldwide. Organophosphorus insecticides have been widely and chronically used to control it, leading to the escalating development of resistance. Recently, odorant binding proteins (OBPs) have been found to play a role in reducing insecticide susceptibility. In this study, we used RT-qPCR to measure the expression levels of four highly expressed OBP genes in the legs of B. dorsalis at different developmental stages and observed the effect of malathion exposure on their expression patterns. The results showed that OBP28a-2 had a high expression level in 5 day old adults of B. dorsalis, and its expression increased after exposure to malathion. By CRISPR/Cas9 mutagenesis, we generated OBP28a-2-/- null mutants and found that they were more susceptible to malathion than wild-type adults. Furthermore, in vitro direct affinity assays confirmed that OBP28a-2 has a strong affinity for malathion, suggesting that it plays a role in reducing the susceptibility of B. dorsalis to malathion. Our findings enriched our understanding of the function of OBPs. The results highlighted the potential role of OBPs as buffering proteins that help insects survive exposure to insecticides.

How well did the consensus methods apply in the guideline development of traditional Chinese medicine: a web-based survey in China.

BACKGROUND AND OBJECTIVE: Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development. METHODS: We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development. RESULTS: The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses. CONCLUSIONS: Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development.

Shufeng Jiedu capsule for acute exacerbation of chronic obstructive pulmonary disease: a protocol of multicentre, randomised, double-blind, placebo-controlled trial.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) represents one of the leading causes of death worldwide. Published clinical trials suggest that the Chinese patent herbal medicine Shufeng Jiedu capsule (SFJD) is safe and may be effective for treating acute exacerbations of COPD (AECOPD). However, these effects have been reported with low or very low certainty evidence. This trial aims to evaluate the effectiveness and safety of SFJD for AECOPD. METHODS AND ANALYSIS: This study is designed as a multicentre, randomised, double-blind, placebo-controlled trial. Three hundred patients with moderate or severe hospitalised AECOPD will be recruited in Beijing, Shanghai and Hefei. Participants will be randomly assigned to SFJD and usual care or placebo and usual care at a ratio of 1:1. SFJD and placebo will be administered orally four capsules three times daily for 7 consecutive days followed by an 8-week follow-up period. The primary outcome will be COPD symptom severity as measured by the EXAcerbation of Chronic Pulmonary Disease Tool score. Secondary outcomes include clinical symptoms, quality of life, length of hospital stay, a total dose of antibiotics, the frequency of recurrence of AECOPD, haematological biomarkers, death and adverse events. This study will answer the question of whether SFJD was safe to use and will improve symptoms in people with AECOPD, and will therefore reduce the necessity for antibiotics, the risk and duration of admission to hospital, and the risk of recurrence. ETHICS AND DISSEMINATION: The ethics committee of the first affiliated hospital of Anhui Medical University, Beijing University of Chinese Medicine affiliated Dongzhimen hospital and fifth people's hospital of Shanghai Fudan University approved the study protocol. Informed written consent will be obtained from all the participants. The results of this trial will be disseminated at academic conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER: ISRCTN99049821.

Selenium nanoparticles improve nickel-induced testosterone synthesis disturbance by down-regulating miR-708-5p/p38 MAPK pathway in Leydig cells.

The present study was designed to investigate the role of miR-708-5p/p38 mitogen-activated protein kinase (MAPK) pathway during the mechanism of selenium nanoparticles (Nano-Se) against nickel (Ni)-induced testosterone synthesis disorder in rat Leydig cells. We conducted all procedures based on in vitro culture of rat primary Leydig cells. After treating Leydig cells with Nano-Se and NiSO4 alone or in combination for 24 h, we determined the cell viability, reactive oxygen species (ROS) levels, testosterone production, and the protein expression of key enzymes involved in testosterone biosynthesis: steroidogenic acute regulatory (StAR) and cytochrome P450 cholesterol side chain cleavage enzyme (CYP11A1). The results indicated that Nano-Se antagonized cytotoxicity and eliminated ROS generation induced by NiSO4 , suppressed p38 MAPK protein phosphorylation and reduced miR-708-5p expression. Importantly, we found that Nano-Se upregulated the expression of testosterone synthase and increased testosterone production in Leydig cells. Furthermore, we investigated the effects of p38 MAPK and miR-708-5p using their specific inhibitor during Nano-Se against Ni-induced testosterone synthesis disorder. The results showed that Ni-inhibited testosterone secretion was alleviated by Nano-Se co-treatment with p38 MAPK specific inhibitor SB203580 and miR-708-5p inhibitor, respectively. In conclusion, these findings suggested Nano-Se could inhibit miR-708-5p/p38 MAPK pathway, and up-regulate the key enzymes protein expression for testosterone synthesis, thereby antagonizing Ni-induced disorder of testosterone synthesis in Leydig cells.

Environmental Effects of Surfactant-Free Silver Nanoparticles on Enzyme Activities, Bacterial Diversity, and Soil Function.

The effects of silver nanoparticles (Ag NPs) on the soil environment have attracted considerable research attention. Previous studies mainly focused on agent-coated Ag NPs, which inevitably introduce additional disturbance of chemical agents to the intrinsic property of Ag NPs. We investigated the environmental effects induced by pure surfactant-free Ag NPs (SF-Ag NPs), including soil enzyme activities (urease, sucrase, phosphatase, and ß-glucosidase), bacterial community structure, and functional profile, over different exposure periods in the present study. The results indicated that these enzymes, especially urease and phosphatases, exhibit different responses to SF-Ag NPs and are more susceptible to SF-Ag NPs than other enzymes. Surfactant-free Ag NPs can also induce a decrease in bacterial diversity and a change of bacterial community structure. The abundance of SF-Ag NPs in Proteobacteria increased, but decreased in Acidobacteria after 14 days of exposure. Moreover, the abundance of genus Cupriavidus was significantly higher than those of the respective controls. By contrast, SF-Ag NP exposure for 30 days could attenuate these negative effects. The phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) prediction revealed that SF-Ag NPs exert a negligible effect on bacterial function, thereby suggesting that functional redundancy is conduced to bacterial community tolerance to SF-Ag NPs. These findings will help us further understand the environmental toxicity of Ag NPs. Environ Toxicol Chem 2023;42:1685-1695. © 2023 SETAC.

Self-Optimized Ligand Effect of Single-Atom Modifier in Ternary Pt-Based Alloy for Efficient Hydrogen Oxidation.

Modifying the atomic and electronic structure of platinum-based alloy to enhance its activity and anti-CO poisoning ability is a vital issue in hydrogen oxidation reaction (HOR). However, the role of foreign modifier metal and the underlying ligand effect is not fully understood. Here, we propose that the ligand effect of single-atom Cu can dynamically modulate the d-band center of Pt-based alloy for boosting HOR performance. By in situ X-ray absorption spectroscopy, our research has identified that the potential-driven structural rearrangement into high-coordination Cu-Pt/Pd intensifies the ligand effect in Pt-Cu-Pd, leading to enhanced HOR performance. Thereby, modulating the d-band structure leads to near-optimal hydrogen/hydroxyl binding energies and reduced CO adsorption energies for promoting the HOR kinetics and the CO-tolerant capability. Accordingly, PtPdCu1/C exhibits excellent CO tolerance even at 1,000 ppm impurity.

Thermally Enhanced and Long Lifetime Red TADF Carbon Dots via Multi-Confinement and Phosphorescence Assisted Energy Transfer.

Thermally activated delayed fluorescence (TADF) materials, which can harvest both singlet and triplet excitons for high-efficiency emission, have attracted widespread concern for their enormous applications. Nevertheless, luminescence thermal quenching severely limits the efficiency and operating stability in TADF materials and devices at high temperature. Herein, a surface engineering strategy is adopted to obtain unique carbon dots (CDs)-based thermally enhanced TADF materials with ≈250% enhancement from 273 to 343 K via incorporating seed CDs into ionic crystal network. The rigid crystal network can simultaneously boost reverse intersystem crossing process via enhancing spin-orbit coupling between singlet and triplet states and suppressing non-radiative transition rate, contributing to the thermally enhanced TADF character. Benefiting from efficient energy transfer from triplet states of phosphorescence center to singlet states of CDs, TADF emission at ≈600 nm in CDs displays a long lifetime up to 109.6 ms, outperforming other red organic TADF materials. Thanks to variable decay rates of the delayed emission centers, time and temperature-dependent delayed emission color has been first realized in CDs-based delayed emission materials. The CDs with thermally enhanced and time-/temperature-dependent emission in one material system can offer new opportunities in information protection and processing.

Chromosome-level genome assembly reveals potential epigenetic mechanisms of the thermal tolerance in the oriental fruit fly, Bactrocera dorsalis.

The oriental fruit fly, Bactrocera dorsalis (Hendel), has very strong ecological adaptability and phenotypic plasticity. Here, the genome of B. dorsalis was assembled into 549.45 Mb sequences with a contig N50 length of 12.81 Mb. Among, 95.67 % assembled genome sequences were anchored on six chromosomes with an N50 length of 94.63 Mb. According to the basic characteristics of the sex chromosomes of Tephritidae, the X chromosome of B. dorsalis was identified. Significant gene expansions were detected in several important gene families related to adaptability. In particular, we annotated 50 histone modification enzymes (HMEs) in this genome. A comparative transcriptome analysis indicated that 12 HME genes were differentially expressed in two thermo-tolerant strains (heat and cold). Interestingly, four and seven of the 12 HME genes responded to heat shock or cold hardening, respectively. These evidences suggested that the histone modification as an epigenetic modification may be involved in the thermal tolerance of B. dorsalis, but with different regulation mechanisms in thermal acclimation and hardening. The high quality genome of B. dorsalis provides an invaluable resource for further functional genomic study. Moreover, comparative genomic analysis will shed insights on revealing the mechanisms of adaptive evolution in this fly.

Ambient Electrosynthesis of Urea with Nitrate and Carbon Dioxide over Iron-Based Dual-Sites.

The development of efficient electrocatalysts to generate key *NH2 and *CO intermediates is crucial for ambient urea electrosynthesis with nitrate (NO3 - ) and carbon dioxide (CO2 ). Here we report a liquid-phase laser irradiation method to fabricate symbiotic graphitic carbon encapsulated amorphous iron and iron oxide nanoparticles on carbon nanotubes (Fe(a)@C-Fe3 O4 /CNTs). Fe(a)@C-Fe3 O4 /CNTs exhibits superior electrocatalytic activity toward urea synthesis using NO3 - and CO2 , affording a urea yield of 1341.3±112.6 µg h-1 mgcat -1 and a faradic efficiency of 16.5±6.1 % at ambient conditions. Both experimental and theoretical results indicate that the formed Fe(a)@C and Fe3 O4 on CNTs provide dual active sites for the adsorption and activation of NO3 - and CO2 , thus generating key *NH2 and *CO intermediates with lower energy barriers for urea formation. This work would be helpful for design and development of high-efficiency dual-site electrocatalysts for ambient urea synthesis.

MgXN2 (X = Hf/Zr) Monolayers: Auxetic Semiconductor with Highly Anisotropic Optical/Mechanical Properties and Carrier Mobility.

Two-dimensional (2D) semiconducting materials with distinct anisotropic physical properties have attracted intense interests. Herein, we show theoretical predictions that MgXN2 (X = Hf/Zr) monolayers are auxetic semiconductors with highly anisotropic electronic, optical, and mechanical properties. The density functional theory calculations coupled with a PSO algorithm (global-minimum search) suggest that both MgHfN2 (MgZrN2) monolayers exhibit orthorhombic symmetry (Pmma) and are direct-gap (indirect-gap) semiconductors with a bandgap of 2.43 eV (2.13 eV). Specifically, the MgHfN2 monolayer exhibits highly anisotropic hole mobility as well as very high electron mobility (∼104 cm2 V-1 s-1). G0W0+BSE calculations indicate that both monolayers bear notable optical anisotropy and relatively large exitonic binding energy (∼0.6 eV). In addition, both monolayers acquire remarkable mechanical anisotropy with a negative in-plane Poisson's ratio (∼-0.2) and high Young's modulus (∼260 N/m). The combination of highly anisotropic electronic, optical, and mechanical properties endows MgXN2 monolayers as potentially useful parts in multifunctional nanoelectronic devices.

Chinese Herbal Medicine for Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials.

Objectives: This study aims to explore the benefits and harms of Chinese Herbal Medicine (CHM) for mild cognitive impairment (MCI). Methods: Electronic searching was conducted in two English and four Chinese databases till 2021 December. Randomized clinical trials on CHM compared to no intervention, placebo or other therapies for MCI were included. Results: Forty-nine RCTs (48 finished trials and 1 protocol) were identified. The overall methodological quality of included trials was relatively low. This review found that compared to no intervention or placebo, CHM can significantly decrease the number of patients who progressed to dementia (RR 0.36, 95% CI 0.22-0.58) and increase the cognitive function assessed by MMSE (MD 1.96, 95% CI 1.41-2.50) and MoCA (MD 2.44, 95% CI 1.57-3.31). The subgroup analysis of different CHM showed that Ginko leaf tablets can significantly improve the cognitive function compared to no intervention or placebo when assessed by MMSE (MD 2.03, 95% CI 1.18-2.88) and MoCA (MD 3.11, 95% CI 1.90-4.33). Compared to western medicine, CHM can significantly increase the score of MMSE (MD 0.88 95% CI 0.46-1.30) and MoCA (MD 0.87, 95% CI 0.33-1.41), but there was no significant difference on the score of ADL (SMD -0.61, 95% CI -1.49 to 0.27). None of the RCTs reported on the quality of life. Of 22 RCTs that reported adverse events, there was no statistical difference between the CHM and the control group. Conclusions: CHM, Ginko leaf extracts in particular, could help to prevent progression into dementia and to improve cognitive function and ability of daily living activities. More qualified RCTs were needed to confirm the conclusion due to the low quality of current trials. Systematic Review Registration: Unique Identifier: CRD42020157148.

Surface-Plasmon-Mediated Alloying for Monodisperse Au-Ag Alloy Nanoparticles in Liquid.

Plasmonic noble-metal nanoparticles with broadly tunable optical properties and catalytically active surfaces offer a unique opportunity for photochemistry. Resonant optical excitation of surface-plasmon generates high-energy hot carriers, which can participate in photochemical reactions. Although the surface-plasmon-driven catalysis on molecules has been extensively studied, surface-plasmon-mediated synthesis of bimetallic nanomaterials is less reported. Herein, we perform a detailed investigation on the formation mechanism and colloidal stability of monodisperse Au-Ag alloy nanoparticles synthesized through irradiating the intermixture of Au nanochains and AgNO3 solution with a nanosecond pulsed laser. It is revealed that the Ag atoms can be extracted from AgNO3 solution by surface-plasmon-generated hot electrons and alloy with Au atoms. Particularly, the obtained Au-Ag alloy nanoparticles without any surfactants or ligands exhibit superior stability that is confirmed by experiments as well as DLVO-based theoretical simulation. Our work would provide novel insights into the synthesis of potentially useful bimetallic nanoparticles via surface-plasmon-medicated alloying.

Laser-ablation assisted strain engineering of gold nanoparticles for selective electrochemical CO2 reduction.

Strain engineering can endow versatile functions, such as refining d-band center and inducing lattice mismatch, on catalysts for a specific reaction. To this end, effective strain engineering for introducing strain on the catalyst is highly sought in various catalytic applications. Herein, a facile laser ablation in liquid (LAL) strategy is adopted to synthesize gold nanoparticles (Au NPs) with rich compressive strain (Au-LAL) for electrochemical CO2 reduction. It is demonstrated that the rich compressive strain can greatly promote the electrochemical CO2 reduction performance of Au, achieving a CO partial current density of 24.9 mA cm-2 and a maximum CO faradaic efficiency of 97% at -0.9 V for Au-LAL, while it is only 2.77 mA cm-2 and 16.2% for regular Au nanoparticles (Au-A). As revealed by the in situ Raman characterization and density functional theory calculations, the presence of compressive strain can induce a unique electronic structure change in Au NPs, significantly up-shifting the d-band center of Au. Such a phenomenon can greatly enhance the adsorption strength of Au NPs toward the key intermediate of CO2 reduction (i.e., *COOH). More interestingly, we demonstrate that, an important industrial chemical feedstock, syngas, can be obtained by simply mixing Au-LAL with Au-A in a suitable ratio. This work provides a promising method for introducing strain in metal NPs and demonstrates the important role of strain in tuning the performance and selectivity of catalysts.

Hierarchical WO3-x Ultrabroadband Absorbers and Photothermal Converters Grown from Femtosecond Laser-Induced Periodic Surface Structures.

Oxygen-vacancy-rich WO3-x absorbers are gaining increasing attention because of their extensive absorbance-based applications in near-infrared shielding, photocatalysis, sterilization, interfacial evaporator and electrochromic, photochromic, and photothermal fields. Thermal treatment in an oxygen-deficient atmosphere enables us to prepare WO3-x but lacks the capacity for finely manipulating the grown structures. In this work, we present that laser-induced periodic surface structure (LIPSS) obtained by femtosecond laser ablation is a good template to grow various hierarchical WO3-x ultrabroadband absorbers and photothermal converters by thermal oxidation annealing in air. Increasing annealing temperature from 600 to 1000 °C allows the manipulation of WO3-x crystal sizes from ∼70 nm to ∼4 µm, accompanied by a color transition from brown to dark blue and finally to yellow. Benefiting from annealing-induced surface cracks and phase transition into WO3-x (containing both WO3 and W18O49) at 600 °C, excellent UV-vis-NIR-MIR ultrabroadband absorbers were produced: >90% UV-NIR absorbance (0.3-2.5 µm) and 50-90% MIR absorbance (2.5-16 µm), much better than most W-based metamaterial absorbers. The higher the annealing temperature (1000 > 800 > 600 °C), the better the photothermal performances (sample temperature as the indicator) of annealed interfaces due to the increased oxidation rates and resultant thicker oxide layers (6, 150, and 507 µm), a trend which is more apparent upon the irradiation of high-density (3160 mW/cm2) and ultrabroadband (200-2500 nm) light but much less apparent for shorter-band (200-800, 420-800, 800-2500 nm, etc.) and less-intensity (1694, 1540, 1460 mW/cm2, etc.) light irradiation. This phenomenon indicates that (1) higher-performance ultrabroadband absorbers possess a higher photothermal conversion capacity; (2) thicker-WO3-x oxide layer converters are more effective in preserving photothermal heat; and (3) both the W-LIPSS and metal tungsten substrate can quickly dissipate the photothermal heat to inhibit heat accumulation in the oxide photothermal converters. It is also proved that ablation-induced high-pressure shockwaves can produce deformation layers in the subsurfaces to release annealing-induced stresses, beneficial for the formation of less-cracked non-stoichiometric WO3-x interfaces upon annealing. High-pressure shockwaves are also capable of inducing grain refinement of LIPSS, which facilitates a homogeneous growth of small non-stoichiometric metal-oxide crystals upon annealing. Our results indicate that femtosecond laser ablation is a convenient upstream template-fabrication technique compatible with the thermal oxidation annealing method to develop advanced functional oxygen-vacancy metal-oxide interfaces.

Chinese herbal medicine for myasthenia gravis: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Myasthenia Gravis (MG) is a disorder of neuromuscular transmission bringing mild ocular weakness to severe generalized muscle weakness and disability. The conventional treatments have long-term side effects, and Chinese herbal medicines (CHM) have shown possible effect and safety for MG patients, but the existing evidence was not robust enough and the results were out of date. METHODS: Searching for randomized controlled trials (RCTs) was conducted in 7 databases and clinical trial registries until July 2021. The ROB 2 tool was used to assess the study quality and GRADE was used to assess the quality of whole evidence. Meta-analyses were conducted and the results were presented as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS: Nineteen RCTs (1283 participants) testing 13 kinds of CHM with adequate randomization were included and six RCTs investigating Compound Huangqi were included in the meta-analyses. In addition to conventional treatment, nine CHMs reduced symptom scores of MG. Compound Huangqi plus conventional treatment (pyridostigmine bromide or prednisone or both) reduced the symptom scores compared with conventional treatment (MD = -3.56, 95%CI -4.86 to -2.26). Less adverse events happened in the CHM groups (3/247 in the CHM groups, 52/245 in the control groups, RR = 0.13, 95%CI 0.06 to 0.30, 9 RCTs, a total of 492 participants). The effect on quality of life was inconsistent. CONCLUSION: Nine CHMs could probably bring benefit for MG symptom improvement. Moderate to low certainty of evidence supported Compound Huangqi added-on conventional treatment probably bring extra benefit of improving MG symptoms. Adding CHMs could be safer than giving only conventional treatment. STUDY REGISTRATION: The protocol was registered in PROSPERO (ID: 32718).

Compound glycyrrhizin injection for improving liver function in children with acute icteric hepatitis: A systematic review and meta-analysis.

BACKGROUND: Compound glycyrrhizin injection (CGI) is a preparation with glycyrrhizin as the main active ingredient extracted from licorice. As clinical trials suggest that CGI is effective in improving liver function for acute icteric hepatitis in children (AIHC), this systematic review aimed to evaluate and verify its therapeutic effects and safety. METHODS: Six electronic databases were searched from their inception to 15 May 2021. Randomized controlled trials (RCTs) assessing therapeutic effects and safety of CGI for AIHC were included. The risk of bias for each trial was assessed using the Cochrane Risk of Bias Tool 2.0. Primary outcomes were indexes related to liver function, including total bilirubin (TBiL), alanine aminotransferase (ALT) and aspartate transaminase (AST). RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool. RESULTS: Six RCTs involving 608 children were included. The overall bias was assessed as having "high risk of bias" in all trials. All trials compared the combination of CGI and conventional western medicine (CWM) with CWM alone. Regarding the effects of CGI for AIHC, results showed that CGI plus CWM was superior to CWM alone in reducing the levels of TBiL (mean difference (MD) = -8.19 mmol/L, 95% CI -9.86 to -6.53), ALT (MD = -24.09 U/L, 95% CI -30.83 to -17.34) and AST (MD = -18.67 U/L, 95% CI -21.88 to -15.45). No trial reported adverse events. The certainty of the evidence for outcomes were all evaluated as low or very low. CONCLUSION: CGI may have adjuvant therapeutic effects on improving the liver function of children with AIHC. There is no evidence to determine the safety of CGI for AIHC. As current evidence is weak, further well-designed RCTs are required for verification of the therapeutic effects of CGI.